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The New York Heart Association (NYHA) Grading of functional capacity of the heart: CLASS I No functional limitation of activity Symptoms with extra ordinary physical work. CLASS II Mild limitation of physical activity. Symptoms with ordinary physical work CLASS III Marked limitation of physical activity Symptoms with less than ordinary physical work CLASS IVSevere limitation of physical activity Symptoms at rest

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2.What is the mortality associated with the various cardiac lesions ?

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3. What is the prognosis for a woman with a cardiac disease depending on the NYHA classification?

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Prognosis depending on the functional status  In general, women in NYHA classes I and II lesions usually do well during pregnancy and have a favorable prognosis with a mortality rate of <1%.  Patients in NYHA classes III and IV may have a mortality rate of 5% to 15%. These patients should be advised against becoming pregnant.

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4. What are the causes for increased cardiac output during a normal pregnancy?

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The fall in the peripheral resistance is about 20-30% at weeks & returns to normal at term. This fall is due to 1. Due to the trophoblastic erosion of endometrial vessels, the placental bed serves as a large arteriovenous shunt causing lowered systemic vascular resistance 2. There is physiological vasodilatation which is believed to be secondary to endothelial prostacyclin and circulating progesterone.

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7. What are the clinical features in a normal pregnancy which can mimic a cardiac disease ?

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The clinical features in a normal pregnancy which can mimic a cardiac disease are 1. Dyspnea - due to hyperventilation, elevated diaphragm.. 2. Pedal Edema 3. Cardiac impulse- Diffused and shifted laterally from elevated diaphragm. 4. Jugular veins may be distended and JVP raised. 5. Systolic ejection murmurs along the left sternal border occur in 96% of pregnant women and are believed to be caused by increased flow across the aortic and pulmonary valves.

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8. What are the criteria to diagnose cardiac disease during pregnancy ?

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The indications for Termination of pregnancy: Because of high maternal risks, MTP is indicated in: 1.Eisenmenger’s syndrome. 2.Marfan’s syndrome with aortic involvement 3.Pulmonary hypertension. 4.Coarctation of aorta with valvular involvement. Termination should be done before 12 weeks of pregnancy.

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10.What is warfarin fetal embryopathy ?

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Warfarin use in first trimester can be teratogenic and can cause fetal embryopathy( 15 to 25 % ) which includes · Nasal cartilage hypoplasia, · Stippling of bones, · IUGR and · Brachydactyly.

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11. What are the risk factors for cardiac failure during pregnancy ?

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12. What is the prophylaxis for Sub acute bacterial endocarditis (SABE) while performing any obstetric and gynecological procedures during pregnancy?

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Antibiotic prophylaxis consists of a. 2 gm ampicillin IV/plus b. 1.5mg per kg gentamicin /IV prior to the procedure, followed by one more dose of ampicillin 8 hours later. In the event of penicillin allergy 1 gm vancomycin IV can be substituted.

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13. Which is the ideal contraceptive for women with heart disease ?